by Marc D. Feldman, M.D.
Abilities That Vanish
People with conversion disorder develop unexplained symptoms or losses in function that are judged to stem from psychological conflicts, not medical conditions. Described as early as 1900 B.C., the symptoms or deficits in conversion disorder tend to occur suddenly and involuntarily and typically affect just a single body function.
Conversion disorder, more commonly mis-named a "hysterical" reaction, is a problem diagnosed in 1% to 3% of patients seen in outpatient mental health clinics, and one that is seen even more frequent in hospitals.
Whereas some conversion patients experience motor deficits such as paralysis, incoordination, or an inability to swallow, others develop sensory problems that may include tunnel vision, deafness, or loss of the sense of touch. In one case, a woman temporarily developed conversion blindness when, on her wedding night, she saw something she had never seen before . . . .
Controversy about the Cause
Around 25% of conversion disorder patients are later diagnosed with authentic medical ailments that account for their symptoms. Even a case of conversion disorder that appears classic can deceive us, and so this diagnosis should be rendered only with exceeding care. Patients diagnosed with conversion must also be reassessed at regular intervals for underlying physical disease.
The complexity of conversion is magnified by the fact that genuine illness and conversion can co-exist. Sometimes, for instance, patients with genuine epilepsy have conversion seizures as well. In a true grand mal-seizure, a patient has massive electrical discharges from all the parts of his or her brain, leading to the body jerking and tongue biting with which most people are familiar. But patients with conversion seizures have normal brain activity even when they appear to be in the throes of a seizure.
Diagnosis
There are a number of clues to the diagnosis of conversion disorder. First are the characteristics of the patients themselves. Conversion disorder is more common among women because they seem to be more vigilant to their own bodies, and thus their bodies are more susceptible to psychological influences.
There is also an increased incidence of conversion disorder among people in rural settings and lower socioeconomic groups, those with anxious or dependent personalities, and those who have recently experienced extreme stress.
Second, diagnosis is simplified when the conversion deficits defy the laws that govern the physiology of the human body. For example, the distribution of "numbness" in a hand or foot may be incompatible with everything known about neurology.
Third, intravenous administration of the barbiturate Amytal or similar medications can help some conversion patients relax enough to become aware of the stressors that precipitated the loss of function. Hypnosis can also assist in unlocking the door, though both techniques must be applied in a way that avoids coercion.
Psychotherapy
Regardless of whether these procedures are used, ongoing psychotherapy is critical. It helps the patient feel understood and supported and also teaches him or her new ways to cope so that conversion disorder remains a thing of the past—even when difficult times hit again.
The goal is for the patient to express through words and appropriate emotional responses, such as crying, what he or she had previously expressed through the body. Behavior therapy to reinforce efforts at normal function can be useful too.
Prognosis
The prognosis for recovery from conversion disorder is generally good. A sudden onset of the conversion symptoms or deficit and the presence of clear-cut stressors that precipitated it are especially favorable prognostic factors.
On the other hand, "rewards" accruing from the conversion (such as disability payments, or oversolicitous handling by family and friends that allows the patient to bask in the sympathy) are associated with a much more drawn-out course. The less prominent the gains, the better the prognosis.
References
Aybek S, Kanaan RA, David AS. The neuropsychiatry of conversion disorder. Curr Opin Psychiatry 2008; 21:275-280
Ballmaier M, Schmidt R. Conversion disorder revisited. Funct Neurol 2005; 20:105-113
Feldman MD, Feldman JM. Stranger Than Fiction: When Our Minds Betray Us. Washington, DC, American Psychiatric Press, Inc., 1998
About the Author:
Marc D. Feldman, M.D. is the author of "Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder" (2004) and co-author of "Stranger Than Fiction: When Our Minds Betray Us" (1998).
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